Annals of Family Medicine最新文献

{"title":"Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?","authors":"Gregory Shumer, Dongru Chen, John Holkeboer, Lauren Marshall, Devon Kinney, Ananda Sen, Michael Klinkman, Katherine J Gold","doi":"10.1370/afm.240299","DOIUrl":"10.1370/afm.240299","url":null,"abstract":"<p><strong>Purpose: </strong>Much of the literature on team-based primary care has focused on physician productivity, workload, and burnout. Less is known about how team-based care influences patient satisfaction and perceptions of the trade-off between continuity and access. This study assessed the preferences of family medicine patients for seeing their primary care physician (PCP) vs other team clinicians based on visit type and wait time.</p><p><strong>Methods: </strong>Our cross-sectional online survey asked patients about their primary care clinics, PCP, portal use, self-reported health, and demographics. For multivariate analysis, we used weighted logistic regression analysis with survey data to calculate maximum likelihood estimates and converted these to odds ratios. We controlled for age and self-reported health as continuous variables and for demographics as categorical variables.</p><p><strong>Results: </strong>We surveyed 4,795 adult patients and received responses from 2,516 (52.5%). More than one-half of patients preferred to see only their PCP for an annual checkup (52.6%), follow-up of a chronic condition (54.6%), or follow-up for a mental health condition (56.8%). Similarly, the majority of patients preferred to wait 3 to 4 weeks to see their PCP for issues possibly requiring a sensitive examination (68.2%), a new mental health concern (58.9%), or a new concern about a chronic condition (61.1%).</p><p><strong>Conclusions: </strong>Our findings show that patients value having a PCP and maintaining continuity with their PCP. They also provide insight on when patients would prefer to wait to see their own PCP vs being seen more quickly by another clinician. As health care delivery and scheduling continue to evolve, these findings provide guidance for leaders in primary care.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"151-157"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision Making Among Racially and/or Ethnically Diverse Populations in Primary Care: A Scoping Review of Barriers and Facilitators.","authors":"Yohualli Anaya, Diana Do, Leslie Christensen, Sarina Schrager","doi":"10.1370/afm.240087","DOIUrl":"10.1370/afm.240087","url":null,"abstract":"<p><strong>Purpose: </strong>Disparities in the use of shared decision making (SDM) affect minoritized patients. We sought to identify the barriers and facilitators to SDM among diverse patients.</p><p><strong>Methods: </strong>We conducted a scoping review in adherence to the Joanna Briggs Institute's methodologic framework. Our search of 4 databases-PubMed, Scopus, CINAHL Plus with Full Text, and PsycINFO-used controlled vocabulary and key word terms related to SDM in the care of racially and/or ethnically diverse adults in the primary care setting. We included peer-reviewed studies conducted in the United States or Canada that evaluated the process of decision making and that had populations in which more than 50% of patients were from racial and/or ethnic minorities. Unique records were uploaded to a screening platform for independent review by 2 team members. We used grounded theory to guide our inductive approach and completed a thematic analysis.</p><p><strong>Results: </strong>A total of 39 studies met all inclusion criteria. We identified 5 overarching themes: (1) factors regarding the decision-making process during the clinical encounter, (2) clinician practice characteristics, (3) trust in the clinician/health care system, (4) cultural congruence between clinician and patient, and (5) extrinsic factors affecting the decision-making process. Barriers of SDM included cultural and language discordance; prejudice, bias, and stereotypes; mistrust; and clinician time constraints. Facilitators of SDM included cultural concordance between clinician and patient; clinician language competence; and clear, honest, and humanistic communication with patients having the ability to ask questions.</p><p><strong>Conclusions: </strong>We identified a set of potentially modifiable factors that facilitate or impede SDM. Our findings can help inform strategies and interventions to improve SDM among racially and/or ethnically diverse patient populations.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"108-116"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Let's Dare to Be Vulnerable: Crossing the Self-Disclosure Rubicon.","authors":"Ohad Avny, Aya Alon","doi":"10.1370/afm.240310","DOIUrl":"10.1370/afm.240310","url":null,"abstract":"<p><p>Physician self-disclosure is frequently employed intentionally to establish rapport, cultivate trust and reciprocity, convey empathy, offer hope and reassurance, or strengthen the credibility of clinical recommendations. Self-disclosure of mental health issues is very personal and is considered to be outside the scope of the patient-physician relationship. This narrative tells my story as a primary care physician trying to help a patient having anxiety and depression. As part of our ongoing motivational discussions, I shared my personal history of mental health issues. Does self-disclosure enhance client-patient rapport and treatment success, or does it hinder such processes?In this case, my self-disclosure successfully overcame impasses in the patient's treatment. Relevant self-revelation accelerated therapy and encouraged my patient to comply with his medication treatment.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"170-172"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrections.","authors":"","doi":"10.1370/afm.250065","DOIUrl":"10.1370/afm.250065","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"92"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heplisav-B vs Standard Hepatitis B Vaccine Booster for Health Care Workers.","authors":"Alan L Williams, Raquelle S Newman","doi":"10.1370/afm.240184","DOIUrl":"10.1370/afm.240184","url":null,"abstract":"<p><p>Confidence in hepatitis B seroprotection for US health care workers includes a complete immunization series followed by a hepatitis B surface antigen antibody (anti-HBs) titer ≥10 mIU/mL. We compared standard hepatitis B vaccines to Heplisav-B (Dynavax Technologies Corp) as a single booster for young, healthy, previously vaccinated individuals. Participants (N = 242) had documentation of a single vaccination series and an anti-HBs titer <10 mIU/mL. In this cohort, 1 booster achieved seropositivity for 92.7% (95% CI, 84.8%-97.2%) of the standard hepatitis B vaccine group and 99.4% (95% CI, 96.6%-100.0%) of the Heplisav-B group. Both boosters are likely to produce seropositivity in this population.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"162-164"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Chlamydia and Gonorrhea in Primary Care and Its Patient-Level Variation: An American Family Cohort Study.","authors":"Shiying Hao, Guoyu Tao, William S Pearson, Ilia Rochlin, Robert L Phillips, David H Rehkopf, Neil Kamdar","doi":"10.1370/afm.240164","DOIUrl":"10.1370/afm.240164","url":null,"abstract":"<p><strong>Purpose: </strong>Chlamydia and gonorrhea are the 2 most common bacterial sexually transmitted infections in the United States. Nonadherence to the Centers for Disease Control and Prevention treatment guidelines remains a concern. We examined how well chlamydia and gonorrhea treatment in primary care settings adhered to guidelines.</p><p><strong>Methods: </strong>We used electronic health records from the PRIME registry to identify patients with diagnosis codes or positive test results for chlamydia and/or gonorrhea from 2018 to 2022. Outcomes were the first dates of antibiotic administered within 30 days after a positive test result for the infection. Descriptive statistics were calculated for patient sociodemographic characteristics. We used a multivariate parametric accelerated failure time analysis with shared frailty modeling to assess associations between these characteristics and time to treatment.</p><p><strong>Results: </strong>We identified 6,678 cases of chlamydia confirmed by a positive test and 2,206 cases of gonorrhea confirmed by a positive test; 75.3% and 69.6% of these cases, respectively, were treated. Females, individuals aged 10-29 years, suburban dwellers, and patients with chlamydia-gonorrhea coinfection had higher treatment rates than comparator groups. Chlamydia was infrequently treated with the recommended antibiotic, doxycycline (14.0% of cases), and gonorrhea was infrequently treated with the recommended antibiotic, ceftriaxone (38.7% of cases). Time to treatment of chlamydia was longer for patients aged 50-59 years (time ratio relative to those aged 20-29 years = 1.61; 95% CI, 1.12-2.30) and for non-Hispanic Black patients (time ratio relative to White patients = 1.17; 95% CI, 1.04-1.33).</p><p><strong>Conclusions: </strong>Guideline adherence remains suboptimal for chlamydia and gonorrhea treatment across primary care practices. Efforts are needed to develop interventions to improve quality of care for these sexually transmitted infections.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"136-144"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the Ambulatory Use of Antibiotics in France Due to the COVID-19 Pandemic in 2020-2022: A Nationwide Time-Series Analysis.","authors":"Nicolas Rousselot, Tchassim Brayan, Catherine Dumartin, Mathieu Clément, Antoine Pariente","doi":"10.1370/afm.230633","DOIUrl":"10.1370/afm.230633","url":null,"abstract":"<p><p>We estimated the changes in the ambulatory use of antibiotics in France due to the COVID-19 pandemic in 2020-2022 by conducting time-series analyses using nationwide data from French health insurance databases. We examined all systemic antibiotics dispensed from January 1, 2010 through March 31, 2022. Use of most antibiotics decreased during the 3-month period following the start of first lockdown (March 17, 2020), and these decreases persisted 12 months later. Some initial increases indicated potential stockpiling for antibiotics used for chronic indications. Azithromycin constituted a noticeable exception. In a context of reduced circulation of non-COVID-19 viruses, the observed decreases compared with forecasts could partly reflect habitual overuse of certain antibiotics.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"158-161"},"PeriodicalIF":5.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stfm Announces New Point of Care Ultrasound Task Force and Initiative on POCUS Family Medicine Education.","authors":"Ryan Paulus, April Davies","doi":"10.1370/afm.250093","DOIUrl":"10.1370/afm.250093","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"173-174"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family-Based Interventions to Promote Weight Management in Adults: Results From a Cluster Randomized Controlled Trial in India.","authors":"Jeemon Panniyammakal, Antony Stanley, Sunaib Ismail, Thoniparambil R Lekha, Sanjay Ganapathi, Sivadasanpillai Harikrishnan","doi":"10.1370/afm.230632","DOIUrl":"10.1370/afm.230632","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the effectiveness of a structured family-based cardiovascular health promotion intervention model in improving weight management among adults.</p><p><strong>Methods: </strong>We conducted an open label, cluster randomized controlled trial (<b>ClinicalTrials.gov NCT02771873</b>) with families serving as the unit of intervention. Families were randomly assigned via computer-generated numbers to receive either the comprehensive package of interventions or enhanced usual care in a 1:1 ratio. Nonphysician health workers delivered the comprehensive package of interventions, which included annual screening for cardiovascular risk factors, structured lifestyle modification sessions, referral to a primary health care facility for individuals with established risk factors, and active follow-up to evaluate self-care adherence. Weight, body mass index (BMI), and waist circumference were measured at baseline, 1 year, and 2 years to assess the intervention's effect on weight management. We used a generalized estimating equation model to analyze the between-group population average changes in these anthropometric parameters.</p><p><strong>Results: </strong>In total, 1,671 participants (1,111 women) from 750 families participated. The mean age of the study population was 40.8 (SD = 14.2) years. The attrition rate at the 2-year follow-up was 3%. The adjusted population average change attributable to the intervention at the 2-year follow-up were -2.61 kg in weight (95% CI, -3.95 to -1.26; <i>P</i> <.001), -1.06 kg/m² in BMI (95% CI, -1.55 to -0.58; <i>P</i> <.001), and -4.17 cm in waist circumference (95% CI, -5.38 to -2.96; <i>P</i> <.001).</p><p><strong>Conclusion: </strong>The reduction in weight achieved in the family-based intervention could have a substantial public health impact in preventing future diabetes and other noncommunicable disease conditions.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"93-99"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resident Leadership Roles and Selection.","authors":"Alysia Herzog, Sarah Holder","doi":"10.1370/afm.250097","DOIUrl":"10.1370/afm.250097","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 2","pages":"177"},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}